Narcissistic people are big bullies
Borderline: See only good or only bad
DEFAULT: Are there good and bad people?
Riffer: Everyone has both parts in themselves. Nobody is all good or all bad.
DEFAULT: How does that show in personality?
Riffer: It shows up primarily in everyday life. The good thing, for example, when we take care of others, i.e. in altruistic behavior. Evil - what is good and what is bad is socially agreed - is sometimes already evident in everyday conflicts, more clearly in bullying and stalking through to physical violence.
DEFAULT: How is it with sick people?
Riffer: We know: this is one and the same person who is sometimes good and sometimes bad. People with a borderline disorder cannot do this, they are dominated by either / or. Those affected do not succeed in experiencing the two parts belonging to one person. The psychiatrist Otto Kernberg published these central and still valid research results on borderline disorders 50 years ago.
DEFAULT: How is it created?
Riffer: The decisive phase of life is the second year of life, says psychoanalysis. During this time the child breaks away from its mother because it learns to walk. That is always ambivalent and associated with fear of being abandoned. And the child learns that there is good and bad in one person, beforehand these two parts are kept separate - split. If there are traumatizing living conditions in this phase or if the accompaniment of "detaching oneself from the mother" is unsuccessful due to excessive fear of abandonment, there is often only the either / or, the good, nurturing or bad, failing mother. This initially gives the toddler orientation and makes his fears bearable. In later life this quality of being able to see both parts "at the same time" in one person is missing. The other person who has just been good, the partner for example, is experienced as evil in the next moment and is aggressively "fought". Behind this is usually this early childhood fear of being abandoned.
DEFAULT: Fairy tales are a topic at the annual congress of the Psychosomatic Center Waldviertel (PSZW). Why?
Riffer: The juxtaposition of love and aggression can be explained well using fairy tales, which the writer Michael Köhlmeier will report on at the congress. In the fairy tale, the split is shown particularly well because the good and bad qualities are mostly divided between two people. There is a wicked witch and a fairy godmother. That's why children love fairy tales that much. Although they know that their mother has both qualities in one person, it is easier to think of them separately.
DEFAULT: And the adults?
Riffer: We too have the desire in us to find a division into good and bad, which calms us down. Just think of politics. Most of us have a good party and an evil party. What is rated as good or bad depends on your personal point of view. We all make this division every day, it gives us orientation. The art is to be able to reunite after keeping apart. In discussions this means: I have this point of view, but can perceive and accept the arguments of the other side. It is about the extent of the division and the ability to overcome it. It is difficult for people with borderline disorder.
DEFAULT: How does that show?
Riffer: Clinically, it has been shown that those affected often cling to relationships because they cannot cope with the severe fear of loss. And the division into good and bad also significantly shapes relationships. Without being comprehensible to the other person, those affected fluctuate between idealizations and devaluations, praise the sky, or - seemingly without cause - become aggressive. The American president is a good example of this.
DEFAULT: Does he suffer from a borderline disorder?
Riffer: From my point of view, he has a narcissistic personality disorder that is closely related to the borderline disorder. On small occasions there is a big thunderstorm, it idealizes and devalues, so that the public cannot stop being amazed. On the other hand, he is afraid, which manifests itself in an enormous vulnerability. Trump says of himself that he is a stable genius. This is the narcissist. He does not apologize, nor does he suffer from his behavior. That is the difference to borderline disorder.
DEFAULT: In what way?
Riffer: Borderline patients are more reflective about their ego. You apologize, suffer. Yet they cannot control their behavior.
DEFAULT: What other signs of borderline are there?
Riffer: We observe a diffusion of identity. If you ask a healthy person: "Who are you?", They can give an answer. He will tell you what job he has, what he likes to do in his free time, what his preferences are. Those affected cannot do that. They often don't know who they are, or they tell many different parts of themselves, and these seem strangely disconnected. Self-injuries, the well-known "cutting" to relieve tension, or the dreaded feeling of "inner emptiness" can be signs.
DEFAULT: Can the disorder only arise in the course of life?
Riffer: Even if causal factors are applied very early, the clinical picture usually develops from the second half of the second decade of life. The diagnosis is made more difficult by the fact that the disease can then only be differentiated from other disorders of adolescence with difficulty.
DEFAULT: What therapeutic options are there?
Riffer: Psychotherapy is the treatment of choice. There are inpatient options for patients with severe forms, such as repeated suicide attempts. We offer that here in Eggenburg. If possible, the therapy should be carried out on an outpatient basis. Ideally, it consists of a combination of individual and group psychotherapy. The former focuses on one's own behavior, in the group the disturbance in interaction with others can be grasped, and changes can be achieved. There is no drug approved for borderline disorders. We can improve fear, aggression or suicidal behavior with medication.
DEFAULT: How good is the prognosis for borderline disorders?
Riffer: Ten years after the prognosis was made, two thirds of the patients no longer meet the diagnostic criteria; in simplified terms, one could say: they are healthy. However, social participation is often bad. Affected people have difficulty in living well in relationships, so they often fail to find long-term partnerships and find it difficult at work. We therefore try to include the psychosocial situation in the therapy. If that succeeds, people around you suffer less from the patient, but also the patient less from themselves. (Bernadette Redl, 5 June 2018)
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